Welcome to DR. STU'S BLOG. Along with my podcast at www.drstuspodcast.com it is here that I post my thoughts on a variety of topics on the birthing world. Advocacy for true informed consent and respect for individual autonomy are the basis for the musings you will read here. I hope you enjoy while you learn and I encourage you to comment. Please check out www.birthinginstincts.com for information on home birthing with an obstetrician and my latest news and updates.

"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.

"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine

"The welfare of humanity is always the alibi of tyrants." Albert Camus

"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.

I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Wednesday, January 29, 2014

The Hazmat Birth

On the header of my blog are a few of my favorite historical
quotes. I think my favorite has become Albert Camus’, “The Welfare of humanity
is always the alibi of tyrants!” Fear is the easiest way to manipulate. And
claiming safety is a perfect way to shut down any discussion. It’s good for
you. It’s safer for the children. You don’t want to put your baby in danger, do
you? We live in a world where ACOG admits that 2/3’s of its guidelines are not based
on good scientific evidence. Yet they put them out anyway. In my world, on a
daily basis, I am told directly or from print media about manipulation of women
through skewed or even overtly false information. When it comes to pregnancy
the bowing to the false god of safety has become the standard. Your baby is too
big. Your baby is too small. Your pelvis is inadequate. The head is smaller
than the shoulders which might get stuck. The fluid is decreasing. The cord is
around the neck. You are 3 days overdue and your placenta is getting weak. VBAC
is too dangerous. Your breech baby’s head might get stuck. Hospitals are safer.
Induction is easy. Cesarean sections are routine.

Then there is the mockery of choosing an alternative to the
fear based standard birthing world. Home delivery is for pizza! Having your
baby at home is like driving your child without a seatbelt (This is the latest flippant
simile from a doctor in Australia. Which, by the way, was how my generation
grew up and I don’t recall massive death on the highway). Or as Jim Gaffigan,
the comedian, quips, “when I told my friends we were having a home birth they
said, Yeah, we were going to do that but we wanted our baby to live!”. Choosing
a home birth is selfish! Why would you pick a lesser trained midwife? How would
you feel when something goes wrong!

Ah, the something goes wrong theory of birth. Perfectly
understandable in today’s fear based, litigious world. Risk management is something
we all do every day. As individuals we just don’t have departments staffed with
lawyers to do our personal risk management. Even if you could afford one can
you imagine your life with every decision being scrutinized for safety and
risk? Susie, you are not allowed to have that chocolate chip cookie because we
have calculated that the risk/benefit ratio is adverse to your long term health
and the viability of your family unit. Laughable? Far-fetched? Maybe, but this
is the climate of the standard medicalized world we now live in. You cannot eat
in labor because there is a 1/100,000 chance you might aspirate in an
emergency. You must have an IV just in case. Please sign these consent forms
about surgery and death after your next contraction. Sorry, hospital policy
says you have to wear those belts continuously.

This past week I came upon a top secret correspondence from
a local hospital that read something like this: “The OBGYN Department and the Infection
Control Division would like to remind you that eye protection (e.g. glasses,
goggles) and a face mask are required for all providers participating in a
delivery. We thank you for your cooperation with this important safety
issue.” The last sentence is
the sinister one. Putting that tagline on anything gives it the appearance of
concern and reasonableness.This may seem like a small thing but its insidious message is a
continuation of the threat to all of us who value individual autonomy and see
vaginal birth as something beautiful. This hospital, likely complying with some
edict from some committee or oversight organization and almost certainly without
a single adverse event in their institution, has turned the birth of a baby
into a hazmat situation. My call to the author of this correspondence for
clarification went unanswered. For those who have actually attended an un-medicated birth, a home birth or a water
birth, can you imagine what the mother must think if she were to look down at a
goggled and masked face catching her baby? I understand for an unscreened
mother wearing protection would be a reasonable choice. But most women are
screened and, unless there has been a series of incidents, universally requiring
this garb is not about safety. It is about protecting the institution from
liability. Plausible deniability should a worker catch something who was not
wearing the hazmat protection hospital policy required. The risk managers are
just doing their job. However, I believe minimizing risk must be weighed
against common sense and personal choice in a free society. Sadly, common sense
is losing and will continue to do so until the masses lose enough services or
are inconvenienced enough that finally tort reform becomes a hot political
topic.

Why have they come forth with
this new rule now would be a logical question. Has there been some epidemic of
exposures? I mean, vaginal birth without mask and goggles has been going on for
millennia. No, it’s simply a symptom of the micromanaged and over-regulated
reality we are now living in. I also just read an editorial about getting rid
of the doctor’s white coat. Why now? Has there been an epidemic of disease
spread by the hospital lab coat? Changing dirty coats makes good sense but
banning them? Will the next suggestion be changing clothes between hospital
wards, between rooms? And why won’t your own clothes be carriers of bad humours
and thus need to be banned. And I can tell you that wearing scrubs from home
and all day and night from the ward, to the call room to the cafeteria does not
sound exactly hygienic. Wearing disposable gown and gloves makes sense in an
infectious disease setting but in the maternity ward, really? So the why now
question is really that someone somewhere just thought it up in response to
usually an isolated incident. There are legions of administrative personnel
whose job it is to try to diminish risk. The foolishness is they believe they actually
can in every case no matter what the consequences down the road. Their job is
to protect their job and their institution and their tyranny is always justified
by safety.

There are two realities in the
birthing world as I see it. One is fear based, often absurd, seeing pregnancy
as illness, believing that interventions make benefit greater than risk and using
safety as a canard for control. The other is trusting of nature, understanding
of the imperfections of life and looking at pregnancy as wellness and a normal
function of the female body. I have lived in both worlds and have a unique
perspective. The first is uncomfortable and often riddled with self-deceit
cloaked in cognitive dissonance. The latter is my choice and I try to be a
vanguard for it. This past week I had the good fortune to attend a beautiful home
VBAC in the hostile birth world of Santa Barbara and an inspirational water birth in
Beverly Hills. I wore a t-shirt and sweat pants and was goggle-less and
mask-less and I am delighted to report I am well and happy.

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Many Voices!

Dear friends, You must know by now that one third of all women in this country are now delivering their babies by cesarean section. This is an amazing statistic when compared to the rest of the world and has to imply that many women are being deprived of choice and having unnecessary surgery often without their full informed consent. I have a teenage daughter. What will the future hold for her and all the future mothers in our country? The current obstetric environment does not bode well for these women and we have yet to experience the full knowledge of the physical and emotional damage being done by all these surgical births. For our beloved daughters and for the sake of all our future mothers the time to stand down is over. Make your voices heard. Thank you so much, Dr. Stu